Effectiveness of the ChAdOx1 nCoV-19 vaccination among COVID-19 patients: a retrospective cohort study

It is currently unknown how effective the COVID-19 vaccine is at preventing new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among the general population. The study suggests that a safe and efficient vaccination against the COVID-19 could help manage this pandemic if widely distributed. The present study aimed to investigate the effectiveness of the ChAdOx1 nCoV-19 vaccine in between vaccinated and unvaccinated cohorts. A retrospective multicenter cohort study comprised 1244 COVID-19 positive patients enrolled in this study from three different hospitals among patients who had been appropriately vaccinated or not between April and June 2021. Data were collected by face-to-face survey, and clinical investigations were obtained by observation. Descriptive statistics and the Cox proportional hazard model of survival analysis were performed in the study. Among the participants, 69% of vaccinated cohorts did not require hospitalization, and 97% successfully recovered from the infection. In respect of age, compared with unvaccinated cohorts, the vaccine effectiveness varied from 81% to 92%. The ChAdOx1 nCoV-19 vaccine was more effective among those aged 60-69 years old and reduced 92% hazard of death than the unvaccinated group [HR ratio - 0.081(.036-.179), P=0.0001]. The study found the ChAdOx1 nCoV-19 vaccine is highly effective for receivers. The COVID-19 vaccination demonstrated a significant correlation with a reduced probability of disease severity, hospital admission rate, early recovery from illness, and mortality.

Factors affecting the outcome of the usage of high-flow nasal cannula on severe or critically ill COVID-19 patients: a multicentric study from a developing nation

In resource-constrained settings, High-Flow Nasal Cannula (HFNC) can reduce the burden on mechanical ventilation in COVID-19 induced Acute Hypoxemic Respiratory Failure (AHRF). The aim was to observe the factors those might affect the outcome of the usage of HFNC on severe/critically ill COVID-19 patients. This is a multicentric prospective observational study. We observed rRT-PCR positive severe/critically ill ICU patients requiring HFNC for more than six hours. Statistical analysis was done to correlate between factors and outcome. Weaning from HFNC was successful in 47.5% of patients. The death rate was higher in 50 years older (56.50%), and patients with asthma (60.57%), COPD (60.00%), and CKD (68.42%). Fever (91.67%), cough (72.5%), and dyspnea (67.5%) were the most common symptoms. Mortality rates were higher for patients with raised blood sugar, creatinine levels. Severely systemic inflammatory response was seen very high for the expired patients. On HFNC, percent saturation of oxygen (SpO2) and partial pressure of oxygen (PaO2) progression was significantly high for the surviving patients requiring less inspired fraction of oxygen (FiO2%). The survival rate was higher for the patients using both HFNC and non-rebreather mask (NRM) concomitantly. While after HFNC- SpO2% and FiO2% were significantly related with outcome of the HFNC only treated patients, duration of hospital stay and on HFNC- FiO2% affected the HFNC + NRM treated patients' outcome. HFNC could save more lives of critically ill AHRF patients who otherwise might need invasive or noninvasive ventilation. Some biochemical tests were observed to have association with the prognosis of the disease though HFNC was given to all. Survival benefit of dual HFNC and NRM therapy needs future study.

Clinical observation of high-flow nasal cannula with non-rebreather mask use on severe or critically ill COVID-19 diabetic patients (preprint)

Background and aims Prevalence of diabetes is a vital factor in COVID-19’s clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) use on critical COVID-19 patients with/without diabetes. Methods For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC (±NRM) treated severe and critical COVID-19 patients (diabetic = 136; non-diabetic = 104) admitted into ICUs of five hospitals in Chattogram, Bangladesh. Results 59.1% of patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic patients (7.41±5.11) (p=0.020). Majority of the hypertensive patients were diabetic (68.3%; p<0.001). Majority of diabetic patients (70.4%; p<0.005) had elevated creatinine levels. Partial pressure of oxygen (mmHg) after HFNC (only) administration was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than in diabetic patients (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had almost similar partial pressure of oxygen (mmHg) from HFNC with NRM. Patients with elevated RBS required NRM with HFNC five times (AOR=5.1, 1.2-20.8) higher than others. Besides age, and hypertension were significantly associated with the HFNC+NRM treated diabetic patients. Factors those affected the HFNC only treated patients were fever and impaired glucose tolerance. Conclusions The results of this study imply that oxygen supply with HFNC and NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that increased blood glucose level could be a determinant for the need of HFNC + NRM treatment. Highlights Elderly diabetic patients required both HFNC and NRM to increase oxygen saturation. Hypertension may be a factor for diabetic patients with COVID-19 requiring HFNC and NRM together. ‘HFNC + NRM’-combination therapy might be needed when blood glucose levels rise.

Relation of vaccination with severity, oxygen requirement and outcome of COVID-19 infection in Chattogram, Bangladesh (preprint)

Introduction: Peoples all around the world are waiting for vaccination against COVID 19 infection. In Bangladesh, Astra Zeneca (AZ) vaccine was provided, but patients had infections of SARS COV 2 even after vaccination. We focused on observing the severity, oxygen requirement and outcome of the COVID-19 infected patients who took the first dose or completed the immunization regimen. Methods: This is an observational study done among 174 COVID 19 patients from three COVID 19 dedicated hospitals of Chattogram, Bangladesh, who took AZ vaccines 1st dose or completed the schedule. All patients were Real-Time Reverse Transcription Polymerase Chain Reaction (rRT PCR) positive for COVID 19. Patients were enrolled after receiving written informed consent. Suspected cases or unwilling patients were excluded from the study. Ethical approval was granted by the CMOSH ERB. SPSS 20 was used to analyze the information gathered. Results: Among 174 vaccinated patients, 55(31.61%) completed the vaccination schedule, and 119(68.39%) took their 1st dose of the COVID 19 vaccine. Gender distributions revealed 67(38.5%) female and 107(61.5%) male got the vaccine, and 55 patients completed the full two doses, and 119 patients took the 1st dose. Most of the patients were 40 years and above. In the completed vaccination group, 33(60.0%) out of 55 in and in the first dose vaccinated group, 75(63.0%) out of 119 had a mild COVID 19, and severe and critical cases were found very minimum. Among the patients who have completed the vaccination, 32(58.2%) needed no oxygen, and who was given the first dose, 78(65%) needed no oxygen. No death occurred who completed the vaccine, and 3(2.5%) patients died who took 1st dose of the vaccine. Conclusion: Vaccine provided in Bangladesh to the people so far seems safe and effective. Severe and critical COVID 19 is low, and the need for oxygen to admitted patients is less, and the death rate is minimal.

Comorbidities of COVID-19 Patients with Low Cycle Threshold (Ct) Value of Nucleocapsid (N) Gene: An Application to Cluster-Based Logistic Model. (preprint)

Background: Coronavirus disease 2019 (COVID-19) is a health crisis throughout the world. The widely used Real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) method is most capable of describing the patient’s condition. Comorbidities can make patients more critical.Methods: In this study, we shed light on the low cycle threshold (Ct) value of the N gene in the rRT-PCR test of the COVID-19 patients who had comorbidities, cure rate, and the needfulness of ICU (Intensive Care Unit) management. We had conducted the research in the Molecular Biology Laboratory of Chittagong Medical College between May and August 2020, then took the telephone interview with 300 positive patients who fulfilled the study criteria. We applied cluster-based logistic regression to analyze the data.Results: Low Ct value of the N gene found 1.324 times more in Type 2 DM patients and 1.871 times higher in hypertensive patients, and hospitalized patients are 2.480 times more vulnerable to shift in ICU.Conclusions: While infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) frequently causes severe diseases, suspected cases with comorbid conditions should go through the rRT-PCR as early as possible.

Comorbidities of COVID-19 Patients With Low Cycle Threshold (Ct) Value of Nucleocapsid (N) Gene: An Application to Cluster-Based Logistic Model. (preprint)

Background: Coronavirus disease 2019 (COVID-19) is a health crisis throughout the world. The widely used Real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) method is most capable of describing the patient’s condition. Comorbidities can make patients more critical.Methods: In this study, we shed light on the low cycle threshold (Ct) value of the N gene in the rRT-PCR test of the COVID-19 patients who had comorbidities, cure rate, and the needfulness of ICU (Intensive Care Unit) management. We had conducted the research in the Molecular Biology Laboratory of Chittagong Medical College between May and August 2020, then took the telephone interview with 300 positive patients who fulfilled the study criteria. We applied cluster-based logistic regression to analyze the data.Results: Low Ct value of the N gene found 1.324 times more in Type 2 DM patients and 1.871 times higher in hypertensive patients, and hospitalized patients are 2.480 times more vulnerable to shift in ICU.Conclusions: While infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) frequently causes severe diseases, suspected cases with comorbid conditions should go through the rRT-PCR as early as possible.

Delay of Detection Of COVID-19 Patients In Bangladesh; An Application To Cox Proportional Hazard Model (preprint)

Objective: To delineate the survival rate of the patients with coronavirus disease 2019 (COVID-19) who did the diagnostic tests lately after the development of symptoms. The aim is to determine the socio-demographic risk factors associated with the delay of the detection of COVID-19 patients. Methods: For this cross-sectional study, 300 patients were selected who were diagnosed as COVID-19 patients in the Molecular Biology Laboratory of Chittagong Medical College, Chattogram, Bangladesh. Data were collected from May to July 2020. Clinical characteristics were obtained from over phone interviews and laboratory diagnosis by Real-time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR). Cox proportional hazard model is applied to estimate risk factors affecting the delay of detection of COVID-19 patients.Result: Female mortality rate was 44.9% higher compared to males, graduates died 32% more than undergraduates, unmarried peoples’ death rate were 56% more than married and those who were in traveling irregularly and in contact with symptomatic patients, were 86% more died than non-travelers.Conclusion: Early diagnosis of COVID-19 can save a huge amount of lives and special attention should be emphasized on the significant explanatory variable.